Treatment of chronic locked posterior dislocation of the shoulder with the modified McLaughlin procedure

Cohen, Marcio; Fonseca, Raphael; Amaral, Marcus Vinícius Galvão; Monteiro, Martim; Filho, Geraldo Rocha Motta

doi:10.1016/j.jse.2021.05.026

Cited by 16 publications

(35 citation statements)

References 33 publications

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“…In the literature, the diagnostic delay is usually no more than six months, but it is particularly striking that the delay in clinical diagnosis and good functional outcomes are disproportionate. [1,32] This literature finding supports the clinical results of our current study.…”

Section: Discussionsupporting

confidence: 91%

“…Cohen et al[ 32 ] conducted a single-center, retrospective study including 10 patients who had the modified McLaughlin procedure to treat persistent LPDS. In their series, their two cases were diagnosed approximately 56 to 52 weeks after from initial trauma, and those had 28 to 22 postoperative CMS, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…[11][12][13][14][15][16] In addition, the literature review revealed that a significant number of neglected (late presenting or overlooked) patients, particularly those with reverse Hill-Sachs lesions between 20 and 45%, were treated with the modified McLaughlin procedure. [1,6,[28][29][30][31][32][33][34]37] Khira and Salama [28] reported the results (n=12) of an open reduction and reconstruction of the humeral head defect using the McLaughlin technique modified by Hawkins et al, [10] in which the insertion of the subscapularis muscle was displaced with lesser tuberosity and augmented with a bone graft from the iliac crest fixed with screws. In their study, the time between dislocation and diagnosis ranged from four weeks to three months, with a mean of eight weeks.…”

Section: Discussionmentioning

confidence: 99%

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Bilateral locked posterior shoulder dislocation overlooked for 15 months treated with the modified McLaughlin procedure: A case report

Saylık¹,

Gokkus

2022

Jt Dis Relat Surg

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Neglected bilateral posterior shoulder dislocation is a rare injury caused primarily by an epileptic seizure. The injury is usually associated with a reverse Hill-Sachs lesion in the anteromedial aspect of the humeral head. The modified McLaughlin technique may avoid instability and osteoarthritis when 20 to 40% of the articular surface is affected by reverse Hill-Sachs. In this article, we present the clinical results of a case overlooked in the literature for the longest time, i.e., for 15 months. A 46-year-old male patient was receiving treatment for epilepsy for five years. There was no fall or trauma in the four seizures he had during this time. The last seizure was 15 months ago. When the patient presented to our clinic, both shoulders were symmetrically deformed, the anterior shoulder contour disappeared (empty socket sign), and there was a loss of upper contour. The computed tomography (CT) scan revealed a posteriorly locked dislocation with a reverse Hill-Sachs lesion in 32% of the left shoulder and 36% of the right shoulder. We applied the modified McLaughlin procedure to the dominant right shoulder and, two months later, we used it to the left shoulder (with a graft taken from the anterior superior iliac spine). At one-year of follow-up, both shoulders were moderately functional: forward elevation left 70° and right 50°, abduction left 40° and right 60°, and internal rotation: the back of the hand could touch the fifth lumbar vertebra. Meanwhile, the patient did not suffer from recurrent dislocation. The pre- and postoperative Constant-Murley Scores for the right and left shoulder were 30/52 and 11/48, respectively. Although the operational outcomes using the modified McLaughlin technique were not ideal, with no recurrence, the patient seemed to be satisfied with this outcome. In conclusion, in neglected locked shoulder fracture-dislocations, the modified McLaughlin technique is a method that can respond to the pathophysiology by eliminating reverse Hill–Sachs lesion.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Bilateral locked posterior shoulder dislocation overlooked for 15 months treated with the modified McLaughlin procedure: A case report

Saylık¹,

Gokkus

2022

Jt Dis Relat Surg

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“…Irreducible dislocations with an RHSL are called "locked" or "fixed" [ 5 ], and cases neglected for more than three weeks are considered "chronic" [ 4 ]. Reverse Hill-Sachs lesions continue to grow while the shoulder remains dislocated [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Treatment and outcomes of chronic locked posterior shoulder dislocations: a retrospective case series

Haritinian

Stoica

Popescu

et al. 2023

BMC Musculoskelet Disord

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Background Posterior shoulder dislocations are rare injuries that are often missed on initial presentation. Cases left untreated for more than three weeks are considered chronic, cannot be reduced closely (they become locked) and are usually associated with a significant reverse Hill-Sachs defect. The aim of this study was to evaluate the outcomes of chronic locked posterior shoulder dislocations treated with the McLaughlin procedure (classic or modified). Methods This retrospective study included 12 patients with chronic locked posterior shoulder dislocation operated on between 2000 and 2021 by two surgeons in two institutions. Patients received a thorough clinical examination and radiological assessment before and after surgery. Shoulders were repaired with the McLaughlin or modified McLaughlin procedure. Outcomes were assessed by comparing pre- and postoperative values of clinical variables. Results Most of the dislocations were of traumatic origin. The average delay between dislocation and surgical reduction was 13.5 ± 9.7 weeks. Postoperative clinical outcomes were favourable, with an average subjective shoulder value of 86.4 ± 11.1 and a normalized Constant –Murley score of 90 ± 8.3. None of the patients had a recurrence of shoulder dislocation, but one patient developed avascular necrosis of the humeral head and two patients developed glenohumeral osteoarthritis. Conclusions In this group of patients with chronic locked posterior shoulder dislocation, the clinical outcomes of McLaughlin and modified McLaughlin procedures were satisfactory, even when surgery was significantly delayed.

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“…Irreducible dislocations with an RHSL are called "locked" or " xed" [5], and cases neglected for more than three weeks are considered "chronic" [4]. Reverse Hill-Sachs lesions continue to grow while the shoulder remains dislocated [13].…”

Section: Introductionmentioning

confidence: 99%

Treatment and outcomes of chronic locked posterior shoulder dislocations: A retrospective case series

Haritinian

Stoica

Popescu

et al. 2022

Preprint

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Background Posterior shoulder dislocations are rare injuries that are often missed on initial presentation. Cases left untreated for more than three weeks are considered chronic, cannot be reduced closely (they become locked) and are usually associated with a significant Hill-Sachs defect. The aim of this study was to evaluate the outcomes of chronic locked posterior shoulder dislocations treated with the McLaughlin procedure (classic or modified). Methods This retrospective study included 12 patients with chronic locked posterior shoulder dislocation operated on between 2000 and 2021 by two surgeons in two institutions. Patients received a thorough clinical examination and radiological assessment before and after surgery. Shoulders were repaired with the McLaughlin or modified McLaughlin procedure. Outcomes were assessed by comparing pre- and postoperative values of clinical variables. Results Most of the dislocations were of traumatic origin. The average delay between dislocation and surgical reduction was 13.5 ± 9.7 weeks. Postoperative clinical outcomes were favourable, with an average subjective shoulder value of 86.4 ± 11.1 and a normalized Constant –Murley score of 90 ± 8.3. None of the patients had a recurrence of shoulder dislocation, but one patient developed avascular necrosis of the humeral head and two patients developed glenohumeral osteoarthritis. Conclusions In this group of patients with chronic locked posterior shoulder dislocation, the clinical outcomes of McLaughlin and modified McLaughlin procedures were satisfactory, even when surgery was significantly delayed.

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Treatment of chronic locked posterior dislocation of the shoulder with the modified McLaughlin procedure

Cited by 16 publications

References 33 publications

Bilateral locked posterior shoulder dislocation overlooked for 15 months treated with the modified McLaughlin procedure: A case report

Bilateral locked posterior shoulder dislocation overlooked for 15 months treated with the modified McLaughlin procedure: A case report

Treatment and outcomes of chronic locked posterior shoulder dislocations: a retrospective case series

Treatment and outcomes of chronic locked posterior shoulder dislocations: A retrospective case series

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